Scribd
Upload
126 views1 page

Revised BBIL Outgoing Wire Transfer Form

The document is an outgoing wire transfer request form containing fields for payment amount, currencies, dates, customer and beneficiary names and account information, intermediary bank details if applicable, remittance information, and authorization signature for debiting the sending account. It collects information necessary to process an international money transfer from one bank account to another.

Uploaded by

RODOLFO
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
126 views1 page

Revised BBIL Outgoing Wire Transfer Form

The document is an outgoing wire transfer request form containing fields for payment amount, currencies, dates, customer and beneficiary names and account information, intermediary bank details if applicable, remittance information, and authorization signature for debiting the sending account. It collects information necessary to process an international money transfer from one bank account to another.

Uploaded by

RODOLFO
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Print Form

REFERENCE:

OUTGOING WIRE TRANSFER REQUEST FORM


PAYMENT AMOUNT CURRENCY DETAILS OF CHARGES DATE REQUESTED (DD/MM/YY)

OUR

50. ORDERING CUSTOMER (ORIGINATOR/ORDERING PARTY)


ACCOUNT NUMBER

FULL NAME

FULL ADDRESS

DATE OF BIRTH/INCORPORATIONp TAX IDENTIFICATION NUMBER

57. ACCOUNT WITH INSTITUTION (BENEFICIARY’S BANK)


BANK IDENTIFIER CODE (SWIFT CODE OR FEDWIRE)

NAME

ADDRESS

59. BENEFICIARY CUSTOMER


ACCOUNT NUMBER OR IBAN

FULL NAME

FULL ADDRESS

70. REMITTANCE INFORMATION (PURPOSE OF TRANSACTION) 72. SENDER TO RECEIVER INFO (OPTIONAL)

56. INTERMEDIARY BANK INFORMATION (WHERE APPLICABLE) ORDERING CUSTOMER’S INFORMATION


BANK IDENTIFIER CODE (SWIFT CODE OR FEDWIRE) LENGTH OF TIME ENGAGED IN BUSINESS

NAME RELATIONSHIP WITH BENEFICIARY CUSTOMER

ADDRESS LENGTH OF RELATIONSHIP WITH BENEFICIARY CUSTOMER

ACKNOWLEDGEMENT
KINDLY DEBIT THE ACCOUNT NUMBER STATED IN FIELD 50. (ORDERING CUSTOMER) ABOVE FOR THE AMOUNT TRANSFERRED (PAYMENT AMOUNT) PLUS CHARGES. I/WE CONFIRM THAT
THE ABOVE INFORMATION IS CORRECT AND THAT I/WE AGREE TO THE TERMS AND CONDITIONS STIPULATED IN THE CLIENT DEPOSIT AND SERVICES AGREEMENT.

AUTHORIZED SIGNATURE(S) PIC: DATE (DD/MM/YY)

OFFICIAL USE ONLY

ULTIMATE BENEFICIAL OWNERS


If an entity, please provide the names of the individuals who own 10% or more of the equity interest of the legal entity (if any), and an individual with significant responsibility to
control/manage the legal entity.
Individual's Name Equity Interest %

COMMENT

INPUTTED BY DATE(DD/MM/YY)

RECOMMENDED BY DATE(DD/MM/YY) VERIFIED BY DATE(DD/MM/YY)

Version 0.2

You might also like